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Prognostic Impact of Therapy-Related CMML

Am J Hematol; ePub 2017 Oct 11; Patnaik, et al

Publish date:: November 5, 2017

Therapy-related chronic myelomonocytic leukemia (tCMML) appears to have unique genetics and carries independent prognostic impact, according to a study involving nearly 500 individuals. Moreover, tCMML has few of the characteristics commonly seen with therapy-related myelodysplastic syndrome/acute myeloid leukemia (t-MDS/AML). Investigators looked at the independent prognostic impact of t-CMML, which was diagnosed in 9% of patients ~7 years after chemotherapy and/or radiation therapy. Among the results:

Compared to those with newly-diagnosed CMML, t-CMML patients had higher LDH levels, higher frequency of karyotypic abnormalities, and higher risk cytogenetic stratification.
There were no differences in the distribution of gene mutations.
Unlike with t-MDS/AML, balanced chromosomal translocations, abnormalities of chromosome 11q23, and Tp53 mutations were rare.
Median overall survival was ~11 months for patients with t-CMML, vs 26 months for those with dysplastic-CMML.
Leukemia-free survival was 50 and 127 months, respectively.
The prognostic impact remained in the context of the Mayo Molecular Model and the GFM prognostic model.

Citation:

Patnaik M, Vallapureddy R, Yalniz F, et al. Therapy related-chronic myelomonocytic leukemia (CMML): Molecular, cytogenetic and clinical distinctions from de novo CMML. [Published online ahead of print October 11, 2017]. Am J Hematol. doi:10.1002/ajh.24939.

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